P1530: CORTICOSTEROIDS FOR INFLAMMATORY RESPONSES DURING INDUCTION CHEMOTHERAPY IN MYELOID MALIGNANCIES ARE NOT ASSOCIATED WITH INCREASED INCIDENCE OF INVASIVE FUNGAL INFECTIONS
Authors: Jorne Migchelbrink, Eva Molendijk, Elizabeth de Kort, Nick de Jonge, Nicole Blijlevens, Walter van der Velden, Suzanne van Dorp
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Corticosteroids have been acknowledged to increase the risk of invasive fungal infections (IFIs). Its use during remission-induction chemotherapy for myeloid malignancies varies between centers. At our institution, corticosteroids are used to treat inflammatory responses related to intensive treatment, including hyperinflammation due to mucositis. Aims: This study explored the use of corticosteroids during induction chemotherapy and investigated whether its use was associated with increased incidence of IFIs. Furthermore we hypothesized that there is a possible beneficial impact of early cessation of hyperinflammation with corticosteroids on the outcome of induction chemotherapy for myeloid malignancies. Methods: A single-center retrospective cohort study was conducted. Medical records of consecutive adult patients treated with remission-induction chemotherapy for high-risk myeloid malignancies between 2018 and 2021 were reviewed for the occurrence of IFIs caused by molds and yeasts. Only probable or proven IFIs (PP-IFIs) according to the 2020 EORTC/MSGERC criteria that occurred during treatment episodes and the following eight days were evaluated. Data on indications for corticosteroid use, clinical features of hyperinflammation and laboratory confirmed bloodstream infections (LCBSI) were collected per chemotherapy course. Results: In total, 152 treatment episodes in 95 patients were included. In the corticosteroid group, a median equivalent cumulative prednisolone dose of 607.5 mg (IQR 273.0-1,087.0) was given. There was no significant difference with regard to incidence of PP-IFIs between the 130 treatment episodes in the corticosteroid group and the 22 treatment episodes in the no corticosteroid group (9.2% vs 9.1%; p = 1.000). Further analysis of the predefined subgroups showed that higher cumulative prednisolone dosages did not significantly influence the incidence of PP-IFIs (12.5%, 4/32 vs 12.5%, 4/32) (p = 1.000). Compared to the no corticosteroid group, the 50 treatment episodes in which hyperinflammation occurred had a significantly lower mean nadir albumin of 21.0 g/L (p < 0.001) and more days (7 vs 0) with serum albumin <25 g/L (p < 0.001). No increase in length of hospital stay was observed when physician’s recognition of hyperinflammation occurred and corticosteroids were given (p = 0.336). Summary/Conclusion: We found no association between the liberal use of corticosteroids during induction chemotherapy for high-risk myeloid malignancies and the incidence of PP-IFIs. The comparable duration of hospital stay between patients receiving corticosteroids for hyperinflammation and the no corticosteroid group may support our hypothesis that use of corticosteroids for hyperinflammation is associated with faster clinical improvement. Further efforts are necessary to evaluate the beneficial effects of corticosteroid use in patients experiencing hyperinflammation due to mucositis.Keywords: Supportive care, Induction chemotherapy, Acute myeloid leukemia, Fungal infection